Minimally invasive surfactant therapy failure: risk factors and outcome

Lobke C.E. Janssen, Jooske van der Spil, Anton H. van Kaam, Jeanne P. Dieleman, Peter Andriessen, Wes Onland, Hendrik J. Niemarkt (Corresponding author)

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2 Citations (Scopus)

Abstract

Objective To evaluate incidence of minimally invasive surfactant therapy (MIST) failure, identify risk factors and assess the impact of MIST failure on neonatal outcome. Design Retrospective cohort study. MIST failure was defined as need for early mechanical ventilation (<72 hours of life). Multivariate logistic regression analysis was performed to identify risk factors for MIST failure and compare outcomes between groups. Setting Two tertiary neonatal intensive care centres in the Netherlands. Patients Infants born between 24 weeks' and 31 weeks' gestational age (GA) (n=185) with MIST for respiratory distress syndrome. Interventions MIST procedure with poractant alfa (100-200 mg/kg). Main outcome measures Continuous positive airway pressure (CPAP) failure after MIST in the first 72 hours of life. Results 30% of the infants failed CPAP after MIST. In a multivariate logistic regression analysis, four risk factors were independently associated with failure: GA <28 weeks, C reactive protein ≥10 mg/L, absence of antenatal corticosteroids and lower surfactant dose. Infants receiving 200 mg/kg surfactant had a failure rate of 14% versus 35% with surfactant dose <200 mg/kg. Mean body temperature was 0.4°C lower at neonatal intensive care unit admission and before the procedure in infants with MIST failure. Furthermore, MIST failure was independently associated with an increased risk of severe intraventricular haemorrhage. Conclusion We observed moderate MIST failure rates in concordance with the results of earlier studies. Absence of corticosteroids and lower surfactant dose are risk factors for MIST failure that may be modifiable in order to improve MIST success and patient outcome.

Original languageEnglish
Pages (from-to)F636-F642
JournalArchives of Disease in Childhood-Fetal and Neonatal Edition
Volume104
Issue number6
Early online date29 Apr 2019
DOIs
Publication statusPublished - 18 Oct 2019

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Surface-Active Agents
Therapeutics
Continuous Positive Airway Pressure
Gestational Age
Adrenal Cortex Hormones
Logistic Models
Regression Analysis
Neonatal Intensive Care
Respiratory Therapy
Neonatal Intensive Care Units
Body Temperature
Artificial Respiration
Netherlands
C-Reactive Protein

Keywords

  • preterm
  • respiratory
  • surfactant
  • Humans
  • Risk Factors
  • C-Reactive Protein/analysis
  • Logistic Models
  • Male
  • Body Temperature
  • Gestational Age
  • Dose-Response Relationship, Drug
  • Netherlands
  • Respiratory Distress Syndrome, Newborn/therapy
  • Intensive Care Units, Neonatal
  • Time Factors
  • Infant, Premature
  • Female
  • Infant, Extremely Premature
  • Pulmonary Surfactants/administration & dosage
  • Adrenal Cortex Hormones/administration & dosage
  • Retrospective Studies
  • Continuous Positive Airway Pressure/methods
  • Infant, Newborn

Cite this

Janssen, L. C. E., van der Spil, J., van Kaam, A. H., Dieleman, J. P., Andriessen, P., Onland, W., & Niemarkt, H. J. (2019). Minimally invasive surfactant therapy failure: risk factors and outcome. Archives of Disease in Childhood-Fetal and Neonatal Edition, 104(6), F636-F642. https://doi.org/10.1136/archdischild-2018-316258
Janssen, Lobke C.E. ; van der Spil, Jooske ; van Kaam, Anton H. ; Dieleman, Jeanne P. ; Andriessen, Peter ; Onland, Wes ; Niemarkt, Hendrik J. / Minimally invasive surfactant therapy failure : risk factors and outcome. In: Archives of Disease in Childhood-Fetal and Neonatal Edition. 2019 ; Vol. 104, No. 6. pp. F636-F642.
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abstract = "Objective To evaluate incidence of minimally invasive surfactant therapy (MIST) failure, identify risk factors and assess the impact of MIST failure on neonatal outcome. Design Retrospective cohort study. MIST failure was defined as need for early mechanical ventilation (<72 hours of life). Multivariate logistic regression analysis was performed to identify risk factors for MIST failure and compare outcomes between groups. Setting Two tertiary neonatal intensive care centres in the Netherlands. Patients Infants born between 24 weeks' and 31 weeks' gestational age (GA) (n=185) with MIST for respiratory distress syndrome. Interventions MIST procedure with poractant alfa (100-200 mg/kg). Main outcome measures Continuous positive airway pressure (CPAP) failure after MIST in the first 72 hours of life. Results 30{\%} of the infants failed CPAP after MIST. In a multivariate logistic regression analysis, four risk factors were independently associated with failure: GA <28 weeks, C reactive protein ≥10 mg/L, absence of antenatal corticosteroids and lower surfactant dose. Infants receiving 200 mg/kg surfactant had a failure rate of 14{\%} versus 35{\%} with surfactant dose <200 mg/kg. Mean body temperature was 0.4°C lower at neonatal intensive care unit admission and before the procedure in infants with MIST failure. Furthermore, MIST failure was independently associated with an increased risk of severe intraventricular haemorrhage. Conclusion We observed moderate MIST failure rates in concordance with the results of earlier studies. Absence of corticosteroids and lower surfactant dose are risk factors for MIST failure that may be modifiable in order to improve MIST success and patient outcome.",
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Minimally invasive surfactant therapy failure : risk factors and outcome. / Janssen, Lobke C.E.; van der Spil, Jooske; van Kaam, Anton H.; Dieleman, Jeanne P.; Andriessen, Peter; Onland, Wes; Niemarkt, Hendrik J. (Corresponding author).

In: Archives of Disease in Childhood-Fetal and Neonatal Edition, Vol. 104, No. 6, 18.10.2019, p. F636-F642.

Research output: Contribution to journalArticleAcademicpeer-review

TY - JOUR

T1 - Minimally invasive surfactant therapy failure

T2 - risk factors and outcome

AU - Janssen, Lobke C.E.

AU - van der Spil, Jooske

AU - van Kaam, Anton H.

AU - Dieleman, Jeanne P.

AU - Andriessen, Peter

AU - Onland, Wes

AU - Niemarkt, Hendrik J.

N1 - © Author(s) (or their employer(s)) 2019. No commercial re-use. See rights and permissions. Published by BMJ.

PY - 2019/10/18

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N2 - Objective To evaluate incidence of minimally invasive surfactant therapy (MIST) failure, identify risk factors and assess the impact of MIST failure on neonatal outcome. Design Retrospective cohort study. MIST failure was defined as need for early mechanical ventilation (<72 hours of life). Multivariate logistic regression analysis was performed to identify risk factors for MIST failure and compare outcomes between groups. Setting Two tertiary neonatal intensive care centres in the Netherlands. Patients Infants born between 24 weeks' and 31 weeks' gestational age (GA) (n=185) with MIST for respiratory distress syndrome. Interventions MIST procedure with poractant alfa (100-200 mg/kg). Main outcome measures Continuous positive airway pressure (CPAP) failure after MIST in the first 72 hours of life. Results 30% of the infants failed CPAP after MIST. In a multivariate logistic regression analysis, four risk factors were independently associated with failure: GA <28 weeks, C reactive protein ≥10 mg/L, absence of antenatal corticosteroids and lower surfactant dose. Infants receiving 200 mg/kg surfactant had a failure rate of 14% versus 35% with surfactant dose <200 mg/kg. Mean body temperature was 0.4°C lower at neonatal intensive care unit admission and before the procedure in infants with MIST failure. Furthermore, MIST failure was independently associated with an increased risk of severe intraventricular haemorrhage. Conclusion We observed moderate MIST failure rates in concordance with the results of earlier studies. Absence of corticosteroids and lower surfactant dose are risk factors for MIST failure that may be modifiable in order to improve MIST success and patient outcome.

AB - Objective To evaluate incidence of minimally invasive surfactant therapy (MIST) failure, identify risk factors and assess the impact of MIST failure on neonatal outcome. Design Retrospective cohort study. MIST failure was defined as need for early mechanical ventilation (<72 hours of life). Multivariate logistic regression analysis was performed to identify risk factors for MIST failure and compare outcomes between groups. Setting Two tertiary neonatal intensive care centres in the Netherlands. Patients Infants born between 24 weeks' and 31 weeks' gestational age (GA) (n=185) with MIST for respiratory distress syndrome. Interventions MIST procedure with poractant alfa (100-200 mg/kg). Main outcome measures Continuous positive airway pressure (CPAP) failure after MIST in the first 72 hours of life. Results 30% of the infants failed CPAP after MIST. In a multivariate logistic regression analysis, four risk factors were independently associated with failure: GA <28 weeks, C reactive protein ≥10 mg/L, absence of antenatal corticosteroids and lower surfactant dose. Infants receiving 200 mg/kg surfactant had a failure rate of 14% versus 35% with surfactant dose <200 mg/kg. Mean body temperature was 0.4°C lower at neonatal intensive care unit admission and before the procedure in infants with MIST failure. Furthermore, MIST failure was independently associated with an increased risk of severe intraventricular haemorrhage. Conclusion We observed moderate MIST failure rates in concordance with the results of earlier studies. Absence of corticosteroids and lower surfactant dose are risk factors for MIST failure that may be modifiable in order to improve MIST success and patient outcome.

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